Provider Demographics
NPI:1841360427
Name:CRAWFORD, LINDA (DO)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 W SIERRA MADRE BLVD
Mailing Address - Street 2:
Mailing Address - City:SIERRA MADRE
Mailing Address - State:CA
Mailing Address - Zip Code:91024-2462
Mailing Address - Country:US
Mailing Address - Phone:626-836-6960
Mailing Address - Fax:626-836-5890
Practice Address - Street 1:95 W SIERRA MADRE BLVD
Practice Address - Street 2:
Practice Address - City:SIERRA MADRE
Practice Address - State:CA
Practice Address - Zip Code:91024-2462
Practice Address - Country:US
Practice Address - Phone:626-836-6960
Practice Address - Fax:626-836-5890
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A5672207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX56720Medicaid
CA20A5672Medicare ID - Type Unspecified
CA00AX56720Medicaid